新发糖尿病视网膜病变伴胰高血糖素样肽-1受体激动剂1例报告。

Jennifer Ko, Yaseman Jahromi
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引用次数: 0

摘要

目的:糖尿病视网膜病变(DR)是中年人获得性视力丧失的主要原因。胰高血糖素样肽-1受体激动剂(GLP-1RA)广泛应用于2型糖尿病(T2D)的治疗。新出现的证据表明,GLP-1 RAs与DR加速之间可能存在联系。然而,关于GLP-1RA治疗与DR风险之间关联的证据不一,并且对于如何管理接受GLP-1RA治疗的患者新发或恶化的DR的指导有限。本病例报告的目的是描述在几种GLP-1RA治疗开始后出现新发和恶化的T2D患者的临床决策管理。病例总结:43岁女性,t2dm, II级肥胖,在接受多种GLP1-RA治疗(即艾塞那肽ER和dulaglutide)并维持血糖控制19个月后,诊断为轻度非增殖性DR。为了进一步减轻体重,患者后来改用皮下注射西马鲁肽,两个月后在右眼检测到糖尿病性黄斑水肿(DME)。由于DR并发症的潜在风险较低,治疗立即转为口服西马鲁肽。患者的眼科检查显示,在转换治疗8个月后,她的DR有所改善,DME明显消失。实践意义:本病例强调了尽管T2D控制良好,但视网膜健康状况的进行性下降,以及GLP-1RA治疗对DR进展的可能贡献。当患者在GLP1-RA治疗中发生DR时,转而使用具有潜在较低DR风险的GLP-1RA药物,如口服semaglutide,可能是有益的。需要进一步的研究来评估GLP-1RA治疗时DR的风险,以及GLP1-RA类的风险。对于GLP-1RA治疗中可能出现的新发或恶化的DR的管理,额外的指导是特别必要的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
New onset diabetic retinopathy with glucagon-like peptide-1 receptor agonists: A case report.

Objectives: Diabetic retinopathy (DR) is a leading cause of acquired vision loss in middle-aged adults. Glucagon-like peptide-1 receptor agonists (GLP-1RA) are widely used in the management of type 2 diabetes (T2D). Emerging evidence has suggested a possible link between GLP-1 RAs and the acceleration of DR. However, the evidence on the association between GLP-1RA therapies and risk for DR has been mixed, and there is limited guidance on how to manage new onset or worsening DR for patients taking GLP-1RA therapy. The objective of this case report is to describe the clinical decision-making involved in the management of a patient with T2D who developed new-onset and worsening retinopathy following the initiation of several GLP-1RA therapies.

Case summary: A 43-year-old female with T2D and class II obesity was diagnosed with mild nonproliferative DR after taking various GLP1-RA therapy (i.e., exenatide ER and dulaglutide) and maintaining glycemic control for 19 months. The patient was later transitioned to subcutaneous semaglutide for additional weight loss, and diabetic macular edema (DME) was detected in the right eye two months after. Due to a potentially lower risk of DR complications, treatment was promptly switched to oral semaglutide. The patient's eye exam revealed that her DR improved and DME had significantly resolved eight months after switching therapy.

Practice implications: This case highlights a progressive decline in retinal health despite well-controlled T2D and the possible contribution of GLP-1RA therapy to DR progression. Switching to GLP-1RA agents with potentially lower risk for DR, such as oral semaglutide, may be beneficial when patients develop DR on GLP1-RA therapy. Further studies that evaluate the risk of DR while using GLP-1RA therapy, as well as the risk across the GLP1-RA class, are needed. Additional guidance on managing possible new onset or worsening DR on GLP-1RA therapy is especially necessary.

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